|
.4 �® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DDlYYYY)
<br />10119/2010
<br />TH S CERTIFICATE IS AS A AND CONFERS NO THIS
<br />����TT
<br />ME�pFTIVH[J`f10?
<br />CERT F CATE DOES NOT AFFIRMATIVELY VEL tEf� EXTEND OR AL ER TIHE COVERAGE A FORDED BY THE POLIC ES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AnnCERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is �1 A ONAL INSURED , licy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the
<br />terms and conditions of the policy, cer4ag l ies may requite Ali 9ndorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s). L
<br />PRODUCER
<br />AOn Risk Insurance services West, Inc.
<br />LOS Angeles CA Office
<br />707 Wilshire Boulevard
<br />Suite 2600
<br />LOS Angeles CA 90017-0460 USA
<br />9
<br />CONTACT
<br />NAME:
<br />PHONE ) (866) 283-7122 (847) 953-5390
<br />(A/C. No. PHONE.,,): A X. No.):
<br />E-MAIL
<br />ADDRES&
<br />PRODUCER 570000036654
<br />CUSTOMER ID #:
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURED
<br />Tetra Tech, Inc.
<br />16241 Laguna Canyon Rd.
<br />Irvine CA 92618 USA
<br />INSURER A: National union Fire Ins CO Of Pittsburgh
<br />19445
<br />INSURER B: insurance Company of the State of PA
<br />19429
<br />INSURERC: Chartis Specialty Insurance Company
<br />26883
<br />INSURERD: Lexington Insurance Company
<br />19437
<br />INSURER E:
<br />INSURER F:
<br />1. VamA"Ma "tnKllri"Alr Ntjmmrw` '1 /1111411.'1.i11Y-I.i WF%Ii�lrlw mllmwFw-
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested
<br />INSIR
<br />LTR
<br />TYPE OF INSURANCE
<br />INSR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDIYYVY
<br />POLICY EXP
<br />MMIDDryI'YY
<br />LIMITS
<br />'4
<br />GENERAL LIABILITY
<br />GL458
<br />101011201
<br />76717=
<br />EACH OCCURRENCE
<br />$1,000,000
<br />SIR applies per policy terns
<br />& condi
<br />ionsDAMAGE
<br />TO RENTED
<br />PREMISES Ea occurrence
<br />$1,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE E OCCUR
<br />MED EXP (Any one person)
<br />$10, 000
<br />X X,C,U Coverage
<br />PERSONAL & ADV INJURY
<br />$1, 000, 000
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />GENT AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMPIOP AGG
<br />T2,000,000
<br />POLICY X PRO--JECT X LOC
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />CA 826 36 72
<br />1 1/,2
<br />011
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$2,000,000
<br />BODILY INJURY ( Per person)
<br />X
<br />ANY AUTO
<br />(� ,i, � -, .. - a .'_
<br />ALL OWNED AUTOS
<br />BODILY INJURY (Per accident)
<br />SCHEDULED AUTOS
<br />PROPERTY DAMAGE
<br />X
<br />HIRED AUTOS
<br />--
<br />-^'
<br />(Per accident)
<br />X
<br />NON OWNED AUTOS-
<br />D
<br />X
<br />UMBRELLA LIAB
<br />OCCUR
<br />TH1000027
<br />1 1
<br />1010112011
<br />EACH OCCURRENCE
<br />$5 , 000, 000
<br />H
<br />SIR applies per policy terns
<br />& Condl
<br />ions
<br />AGGREGATE
<br />$5,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DEDUCTIBLE
<br />X
<br />RETENTION $100,000
<br />B
<br />WORKERS COMPENSATION AND
<br />WC14770806
<br />10/01/2010
<br />10/Ol/2011
<br />X WC sTATU- OTH-
<br />EMPLOYERS' LIABILITY YIN
<br />TCRY LIMITS R
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />ANY PROPRIETOR / PARTNER / EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />N I A
<br />E.L. DISEASE -EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />E.L. DISEASE -POLICY LIMIT
<br />$1, 000, 000
<br />DESCRIPTION OF OPERATIONS below
<br />I
<br />I
<br />c
<br />Contractor Prof
<br />OPS1952583
<br />10/01/2010
<br />10/01/2011
<br />Each Clain
<br />$5,000,000
<br />TP
<br />rof/Poll Liab
<br />Agggregate
<br />$5,000,000,
<br />Deductible
<br />$250,000
<br />1
<br />DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />Project: 134P00597-0086-00, on -Call Engineering Design Services for water and Sewer Main Improvement Project. The City of
<br />Santa Ana, 20 Civic Center Plaza, Santa Ana, CA 92701, its officers, employees, agents, volunteers and representatives are
<br />included as Additional Insured as respects to General Liability policy as required by contract. Coverage is Primary and
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE NTH THE
<br />POLICY PROVISIONS.
<br />city Of Santa Ana - Public Works Agency AUTHORIZED REPRESENTATIVE
<br />Attn: Cesar E. Barrera
<br />t. Engineer II �
<br />220 S. Daisy Avenue, M
<br />San-85
<br />Santa Ana CA 92702 USA GDSV.L•d
<br />M
<br />rn
<br />co
<br />0
<br />O
<br />Z
<br />dl
<br />t0
<br />U
<br />w
<br />t
<br />d1
<br />U
<br />©1988-2009 ACORD CORPORATION. All rights reserve
<br />l
<br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
<br />
|